Suicide is the most likely cause of death for people ages 15 to 34, according to a report by the Chinese Association for Mental Health, China Daily reports.

China Daily said 250,000 people commit suicide in mainland China each year, which translates into one suicide and eight attempts every two minutes, giving China the world’s highest suicide rate.

Yang Fude of Beijing Huilongguan Hospital said in an interview with China Daily that where people commit suicide is also unusual. “It is also one of the few countries where rural suicides outnumber urban suicides,” he said. “In China, the ratio is three to one.”

Adolescent suicide rates had been dropping steadily since 1996, but spiked in 2004. The rate dropped in 2005, but not as much as experts had hoped, findingDulcinea reports. Teen suicides in Canada showed a similar trend. Some are worried that the increase coincides with a drop in antidepressant use following concerns about the medications causing suicidal thoughts.